Flaps are widely used in the surgical reconstruction of the nasal region. During the post-operative period, an unattractive depressed scar in relation to the nearby skin can be observed. Even after abrasion – which the literature recommends 30-60 days after the procedure – this complaint often persists. This study proposes tangential excisions with a razor blade (shaving) of the flap''''''''s entire area until it is level with the surrounding region, followed by dermabrasion to refine any remaining irregularities. The results are deemed excellent since the scars become less noticeable – a very satisfactory outcome due to the aesthetic and social importance of the treated area.

Keywords: SURGICAL FLAPS, NEOPLASMS, DERMABRASION

Early diagnosis of basal cell carcinoma-a cutaneous neoplasia with high incidence-can bring great benefits to the patient. Often, slightly pigmented lesions, small initial lesions, and superficial lesions can represent a clinical and dermoscopic diagnostic challenge for not having the typical findings of this neoplasia. In such cases, optical coherence tomography-a promising technology in dermatology-is an auxiliary, non-invasive resource that can be incorporated into the clinical practice.

Keywords: BASAL CELL CARCINOMA, DIAGNOSTIC IMAGING, OPTICAL COHERENCE TOMOGRAPHY.

The dorsum of the hand is home to tumors that often require a surgical approach. Due to limited cutaneous mobility, wide surgical wounds become a challenge to dermatologic surgeons. The authors report the case of a patient with a tumor in the dorsal region of the left hand that, after removal with a safety margin, resulted in a wide surgical wound, and in the choice of reconstruction with an A-T flap. Six months later, the patient was cured, with total preservation of the hand's mobility and excellent aesthetic results. The concept of using flaps for closing wide surgical wounds, whenever possible, is reinforced.

Keywords: HAND, NEOPLASMS, SURGICAL FLAPS.

Onychomatricomas are rare benign tumors originating from the nail matrix and underlying stroma. They are usually asymptomatic and slow growing, affecting both middle-aged men and women, and more frequently involve the digits of the hands. Key clinical features for diagnosis are: yellowish longitudinal band of variable width, splinter hemorrhages, longitudinal grooves associated with the transverse overcurvature and fingerlike projections emerging from the nail matrix. The authors report three cases of this tumor affecting toes, emphasizing main clinical aspects, dermoscopic findings, and surgical treatment.

Keywords: NAILS; NAILS, MALFORMED; NEOPLASMS.

Dermatologists have recently been incorporating diagnostic imaging techniques in the investigation of cutaneous lesions. The development of ultrasound devices with a frequency greater than 15MHz has led to the creation of the high-frequency ultrasound (HFUS), which enables the identification of the skin's different layers and structures as well as appendages. This has expanded its use considerably in various dermatological conditions, particularly in cutaneous neoplasms. Its association with color Doppler allows the study of tumor microcirculation. In the present paper, the authors discuss the main clinical characteristics of malignant cutaneous neoplasms and how high-frequency ultrasound allows a better pre-operative evaluation of those lesions.

Keywords: ULTRASONOGRAPHY; SKIN NEOPLASMS; DIAGNOSIS.

Introduction: Cutaneous melanoma has significant relevance among malignant skin tumors, for despite its low incidence (3-4%) it is associated with the highest mortality. In Brazil, estimates for the year 2014 correspond to 10% of all cancers, establishing this as an important public health issue. Objectives: To present epidemiological data related to melanoma skin cancer in the midlands of the Brazilian State of São Paulo. Methods: Descriptive retrospective cross-sectional analysis of data from a tertiary hospital's medical records. The analysis was subject to measurement and information bias. A descriptive analysis with frequency and percentage was carried out. Results: There was a prevalence of cutaneous melanoma in women (71%), patients between 50 and 70 years of age (56%), Caucasians (78%), and individuals who identified their lesions through self-examination (42%), with predominant involvement of the trunk (35%). The most prevalent histological subtype was the superficial spreading (58%). Conclusions: Understanding the epidemiology of cutaneous melanoma in a given geographic region enables and facilitates medical actions, allowing for the better establishment of strategies for primary and secondary prevention.

Keywords: MELANOMA, EPIDEMIOLOGY, SKIN NEOPLASMS.

Eccrine spiradenoma is a rare benign adnexal epithelial neoplasm characterized by a bluish-pink, slow-growing solitary nodule, coursing with paroxysmal pain, mainly in young adults. It is most commonly located in the trunk and extremities. Bleeding and/or ulceration are common in the giant vascular variant, which is characterized by a size greater than 2 cm in diameter and a high degree of vascularization seen on histology. Its clinical characteristics are unspecific and require biopsy with histological analysis for diagnosis. Its histology presents one or more basophilic intradermal lobules enveloped in a fibrous capsule without connection to the epidermis. It presents two types of cells: small cells with dark nuclei in the periphery and large cells with light nuclei in the center. An accurate diagnosis is important due to the fact that it can develop into a potentially fatal malignancy - which is a rare phenomenon and occurs most often in the multiple variant. A rare case of eccrine spiradenoma in the abdomen with bleeding associated is described in the present paper, as well as a discussion on possible treatments.

Keywords: ECCRINE SPIROADENOMA, BENIGN EPITHELIAL NEOPLASIA, SEBACEOUS GLANDS

The acquired perforating dermatosis is constituted by a group of diseases whose main characteristic is the transepithelial elimination of altered dermal material. It has the clinical appearance of crateriform papules or nodules, with central keratotic plug, which may suggest some kind of transepithelial purging; nevertheless the final diagnosis is histologic. The dermoscopic examination is a useful tool that helps to exclude similar dermatoses, such as nodular prurigo and hypertrophic lichen planus. The present article discusses the clinical and dermoscopic correlation of this dermatosis.

Keywords: DERMOSCOPY; PRURIGO; DIAGNOSIS, DIFFERENTIAL

Introduction: Non-melanoma skin cancer is among the most frequent neoplasms in Brazil and is deemed a public health problem. Initial diagnosis is based on clinical suspicion and includes dermoscopy. Confirmation is carried out via histological analysis. Dermoscopy also contributes to the demarcation of tumor safety margins. Objective: To analyze the accuracy of dermoscopy in the diagnosis of non-melanoma skin cancer and its effectiveness in defining the lateral margins of these tumors in excisional biopsies. Methods: Comparison of the dermoscopy-based diagnostic hypothesis with the final histological outcome and involvement of lateral margins. Results: The data relating to a total of 70 lesions suspicious of non-melanoma skin cancer arising from a group of 50 patients were evaluated from 2015 to 2017. The comparison of the diagnostic hypothesis with the final histological outcome after excisional biopsy, indicated success rates of 79.6% for suspected cases of basal cell carcinoma and 23.8% for squamous cell carcinoma. Safety margins were observed in 74% of basal cell carcinomas and in 60% of squamous cell carcinomas. Conclusions: The diagnosis of non-melanoma skin cancers depends on experienced dermatologists and pathologists, with the interaction between these professionals being crucial. Dermoscopy has contributed in a more significant way to the diagnosis of basal cell carcinoma when compared to that of squamous cell carcinoma.

Keywords: SKIN NEOPLASMS; DIAGNOSIS, DIFFERENTIAL; MARGIN

Scabies is a contagious cutaneous infection, caused by burrowing of the mite Sarcoptes scabiei var. hominis in the epidermis. The clinical suspicion is due to the history, clinical distribution of lesions and its aspect; however, the confirmation is with the detection of the parasite. We present the features of the diagnostic methods for scabies, from its detection through direct microscopy of skin scrapings from a lesion or with the use of an adhesive tape on the lesions, to its detection using the dermatoscope, a tool available in most dermatology clinics, which, even in unexperienced hands, has acceptable sensitivity and specificity.

Keywords: Dermoscopy; Diagnostic imaging; Microscopy; Scabies; Skin and connective tissue diseases; Skin diseases;

O queratoacantoma (QA), apesar de frequente na prática diária, é um tumor que gera questionamentos. O aspecto mais intrigante associa-se à sua posição no limite entre malignidade e benignidade. A abordagem do tumor, bem como sua classificação, é controversa. Na definição da conduta, é importante levar em conta o potencial de transformação para carcinoma espinocelular. Desse modo, a excisão cirúrgica é a terapia de escolha, sempre que possível. Algumas situações merecem atenção adicional, como a imunossupressão associada. Neste artigo, relatamos um caso de QA gigante em um paciente com síndrome da imunodeficiência adquirida tratado com cirurgia micrográfica de Mohs.

Keywords: Ceratoacantoma; Retalhos Cirúrgicos; Neoplasias Nasais; Neoplasias Cutâneas; Cirurgia de Mohs; Síndrome de Imunodeficiência Adquirida; HIV; Imunossupressão

The reconstruction of deep surgical defects of the nasal tip and wing of the nose often presents a challenge to the surgeon. In these cases, full-thickness skin grafting is widely used, but it often results in sinking or graft depression. We present a surgical technique that is easy to perform and reproducible; nonetheless still very little diffused in Brazil: the “Drumhead” graft. This method performs the grafting of a rigid plastic suspension together with the full-thickness skin graft. Thus, this technique constitutes another tool for the dermatological surgeon to prevent irregularities of undesirable contours, graft depression, and nasal vestibule collapse.

Keywords: Nose; Nose neoplasms; Skin neoplasms; Skin transplantation

INTRODUCTION: The perioral region is commonly affected by non-melanoma skin cancer. Mohs micrographic surgery is the treatment of choice in this area because it has the highest cure rate and preserves healthy tissue. Several methods are available for restoring the perioral region, and their selection is influenced by the surgical wound characteristics and the surgeon's preference.
OBJECTIVE: Describe the authors’ experience in perioral reconstruction after Mohs micrographic surgery and analyze the repair methods most frequently performed.
METHODS: Retrospective study of consecutive cases submitted to Mohs surgery and perioral reconstruction.
RESULTS: The study included 108 cases from 103 patients. The mean number of Mohs surgery stages was 1.4, and the mean defect size was 16 mm. Primary closure was the most used technique for reconstruction, followed by flaps (mainly V-Y, single advancement, and rotation). The association of repair methods was used in 28.7% of cases, mostly combined with flaps. Four patients had complications (necrosis and graft infection, trapdoor effect, and partial wound dehiscence).
CONCLUSION: Primary closure was the most frequent repair method, followed by flaps. Knowing reconstruction strategies and possibilities of associations is essential for proper restoration of the perioral region, maintaining its functionality, sensitivity and aesthetics.

Keywords: Lip; Lip neoplasms; Mohs surgery; Skin neoplasms

Riziform bodies are structures in the synovial fluid or attached to the synovium, which macroscopically resemble rice grains. They are common in patients with rheumatoid arthritis and result from a chronic inflammation. They are found in 25% of aspiration procedures or joint surgery. However, there are still no publications reporting its presence in the subcutaneous tissue. We report for the first time the occurrence of riziform bodies in the subcutaneous plane of the palmar region in a patient with rheumatoid arthritis, confirmed by sonographic and anatomopathological examination, successfully treated with surgical drainage, without recurrences after two years of follow-up.

Keywords: Abscess; Rheumatoid arthritis; Dermatopathies; Hand dermatoses; Outpatient Surgical Procedures; Surgical Diagnostic Techniques

We report a case of a 72-year-old man who underwent surgical excision of a keratoacanthoma centrifugum marginatum (KCM) located on the left forearm. It is an uncommon variant of keratoacanthoma, which can assume large dimensions (up to 20 cm) and does not tend to spontaneous regression. The lesion is usually single, with raised borders, and has progressive centrifugal growth associated with central healing and atrophy. Due to its rarity and lack of pathognomonic histopathological features, KCM can be a diagnostic challenge for dermatologists and pathologists.

Keywords: Keratoacanthoma; Neoplasms; Skin neoplasms